Case Report: Acute Onset Fear of Falling and Treatment With “Cognitive Physical Therapy”
Journal
Frontiers in Neurology
ISSN
1664-2295
Date Issued
2021
Author(s)
Shree Vadera
Matthew James Bancroft
Joseph Buttell
Diego Kaski
Type
Resource Types::text::journal::journal article
Abstract
<jats:p>Fear of falling (FoF) is prevalent in older adults, especially those with previous falls, and typically starts insidiously. We present a 78-year-old woman with an abrupt onset FoF and no history of falls, balance problems, vertigo, oscillopsia, psychiatric or psychological issues to account for this. These cognitive changes led to a behavioural alteration of her gait that became slow and wide-based, with her gaze fixed on the floor. She began a tailored program of “Cognitive Physical Therapy (CPT)” combining cognitive behavioural therapy (CBT) and physical rehabilitation. 1 month later her 6 m walk time and steps were reduced by a 25 and 35%, respectively, and the stride length increased by 34%, with further improvement 2 months later. We postulate that the abrupt onset of symptoms triggered a central shift toward postural hypervigilance and anxiety, suppression of anticipatory (feed forward) postural adjustments (APA) leading to FoF. CPT improved objective gait parameters related to FoF and reduced postural anxiety suggesting that early diagnosis and prompt treatment may avoid chronic symptoms and social isolation.</jats:p>
Subjects
fear of falling
;
falls
;
postural anxiety
;
cognitive behavioural therapy
;
cognitive physical therapy
;
alendronic acid
;
atorvastatin
;
indapamide
;
levothyroxine
;
ramipril
;
vitamin d
;
aged
;
alertness
;
anxiety
;
article
;
case report
;
clinical article
;
cognitive behavioral therapy
;
cognitive physical therapy
;
daily life activity
;
falls efficacy scale
;
fear of falling
;
female
;
gait
;
hospital anxiety and depression scale
;
human
;
mental disease
;
physiotherapy
;
sensory feedback
;
six minute walk test
;
state trait anxiety inventory
;
stride length
;
task performance
;
walking speed